Complete Your CE Test Online - Click Here written and signed prescription to the pharmacist within 7 days. Further, the pharmacist must notify DEA if the prescription is not received. To expedite the filling of a prescription, a prescriber may transmit a Schedule II prescription to a pharmacy by facsimile (fax). However, the original Schedule II prescription must be presented to the pharmacist for review prior to the actual dispensing of the controlled substance. DEA has granted three exceptions to the fax prescription requirements for Schedule II controlled substances. The fax of a Schedule II prescription may serve as the original prescription for patients in long- term care facilities or hospice, and for Schedule II medications that must be compounded for injection [25]. Schedules III–V prescribing requirements Prescriptions for controlled substances in Schedules III, IV, and V may be communicated to the pharmacist orally, in writing, or by fax, and may be refilled if so authorized on the prescription or by call-in. However, such prescriptions may only be refilled up to five times within 6 months after the date on which the prescription was first issued. After five refills or after 6 months, whichever occurs first, a new prescription is required [26]. Appropriate and inappropriate prescribing practices The legal standard that a controlled substance may only be prescribed, administered, or dispensed for a legitimate medical purpose by a physician acting in the usual course of professional practice has been construed to mean that the prescription must be “in accordance with a standard of medical practice generally recognized and accepted in the United States [27].” Nonetheless, there are recurring patterns that suggest inappropriate prescribing of controlled substances by a clinician [28]: ● ● An inordinately large quantity of controlled substances prescribed or large numbers of prescriptions issued compared with other physicians in an area. ● ● No physical exam was given. ● ● Warnings to the patient to fill prescriptions at different drug stores. ● ● Issuing prescriptions knowing that the patient was delivering the drugs to others. ● ● Issuing prescriptions in exchange for sexual favors or for money. ● ● Prescribing controlled drugs at intervals inconsistent with legitimate medical treatment. ● ● The use of street slang rather than medical terminology for the drugs prescribed. ● ● No logical relationship between the drugs prescribed and treatment of the condition allegedly existing. Each case must be evaluated on its own merits in view of the totality of circumstances particular to the physician and patient. Nursing consideration: Nurses, who take orders for controlled substances, must know who may (and who may not) prescribe scheduled substances and what the order and/or prescription must include. Disposal and loss of controlled substances A practitioner may dispose of out-of-date, damaged, or otherwise unusable or unwanted controlled substances, including samples, by transferring them to a registrant who is authorized to receive such materials [29]. These registrants are referred to as “Reverse Distributors” by the Department of Justice. The practitioner should contact their local DEA field office for a list of authorized Reverse Distributors. [For addresses and telephone numbers of field offices, please see the DEA website: fullSearch;jsessionis=DEDBAE8EC5837D4B34661E5075DC4749? execution=e1s1] Schedule I and II controlled substances should be transferred via DEA Form 222, while Schedule III–V compounds may be transferred via invoice. The practitioner should maintain copies of the records documenting the transfer and disposal of controlled substances for a period of 2 years [30]. Practitioners should notify the DEA field office in their area of the theft or significant loss of any controlled substances upon discovery, and complete a DEA Form 106 regarding such theft or loss [31]. Preventing drug diversion when prescribing controlled substances Epidemiology of chronic pain and opioid abuse Chronic pain is a prevalent condition in the United States. DiPiro et al states that [39]: “Fifty million Americans are partially or totally disabled because of pain. The annual cost of pain to U.S. society can be estimated to be in the billions of dollars. In 1 year, an estimated 25 million Americans will experience acute pain due to injury or surgery, and one third of Americans will experience severe chronic pain at some point in their lives. These numbers are expected to rise, as increasingly more Americans work beyond age 60 years and survive into their 80s [39].” Due to the high prevalence of chronic pain, opiate abuse continues to be a burden to society. On a global scale, the U.N. Office on Drugs and Crime states “between 26.4 and 36 million people are estimated to abuse opiates in 2012 [40].” EBP alert! Research shows that between 26.4 and 36 million people are estimated to abuse opiates in 2012. Nurses and other healthcare professionals must be aware of the high prevalence of opiate prescription for chronic pain, the high numbers of people who are estimated to abuse opiates, how to recognize those at risk for abuse, and how to identify those who are already abusing opiates [40]. Prescription drug abuse and misuse [38] The Substance Abuse and Mental Health Services Administration supports the following definition of the continuum of use of psychoactive prescription medications: ● ● Proper use – Taking only medications that have been prescribed, for the reasons the medications are prescribed, in the correct dosage, and for the correct duration. ● ● Misuse (by patient). ○ ○ Taking higher doses than prescribed. ○ ○ Longer duration than prescribed. ○ ○ Used for purposes other than prescribed use. ○ ○ Used in conjunction with other medications or alcohol. ○ ○ Skipping doses/hoarding drug. ● ● Misuse (by practitioner). ○ ○ Prescription for inappropriate indication. ○ ○ Prescription for unnecessary high dose. ○ ○ Failure to monitor or fully explain appropriate use. ● ● Abuse (by patient). ○ ○ Use resulting in declining physical or social function. ○ ○ Use in risky situations (hazardous use). ○ ○ Continued use despite adverse social or personal consequences. ● ● Dependence. ○ ○ Use resulting in tolerance or withdrawal symptoms. ○ ○ Unsuccessful attempts to stop or control use. ○ ○ Preoccupation with attaining or using the drug. Misuse and abuse are distinct from medication mismanagement problems, such as forgetting to take medications, and confusion or lack of understanding about proper use. Medication mismanagement problems can also have serious consequences for patients, but they have different risk factors and typically require different types of interventions. Nursing consideration: Nurses must be able to differentiate between misuse, abuse, and dependence in order to provide appropriate nursing interventions [38]. Page 4